Adherence to Health Behavior Recommendations among Youth with Obesity Classes I, II, and III

Background: Previous research has not examined whether youth with obesity class I, II, or III differ in adherence to health behavior recommendations. Objective: To examine differences in meeting recommendations for physical activity (PA), screen time (ST), fruit/vegetable (F/V), dairy, and water consumption by obesity class. Methods: Data were from primary care visits from 2013 to 2019 among youth ages 2–17 years with obesity. A brief survey was used to capture adherence to five different health behaviors. Logistic regression compared odds of adherence across obesity classes (I vs. II/III; II vs. III). Results: Among 11,525 youth with obesity, rates of meeting recommendations were 78.6% (PA), 55.0% (ST), 8.1% (F/V), 29.6% (dairy), and 54.7% (water). In adjusted models, compared with youth with obesity class I, youth with obesity class II and class III had lower odds of meeting PA (odds ratio [OR CII ] = 0.63, 95%CI = 0.56, 0.72; OR CIII = 0.60, 95%CI = 0.49, 0.72), and ST recommendations (OR CII = 0.83, 95%CI = 0.74, 0.92; OR CIII = 0.78, 95%CI = 0.65, 0.94). No differences were observed between obesity class II and class III. Conclusions: Youth with different classes of obesity demonstrate different adherence to ST and PA recommendations. Pediatric primary care providers can utilize these findings to determine adherence barriers and tailor their counseling for patients with severe obesity.